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General NPI Number Information
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NPI Number | 1265795181
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Entity Type | Individual
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Provider Name | CHRISTINA VASSALLO APN
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Gender | Female
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 62 S FULLERTON AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2676
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Country | US
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Telephone | 973-706-2171
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Fax | 973-780-9688
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Provider Business Mailing Address
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Address Line | 1 DIAMOND HILL RD
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City | BERKELEY HEIGHTS
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State | NJ
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Zip | 07922-2104
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Country | US
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Telephone | 908-273-4300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00382400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00382400
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 26NJ00382400
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License Number State | NJ
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